Telemedicine during the FIFA World Cup 2022: a potential tool to curtail the spread of infectious disease during times of pandemic
Authors: Ismail Dergaa, Karim Chamari, Ramadan Abdelmoez Farahat, Mohamed Romdhani, Morteza Taheri, Ziad A. Memish, Samya A. Al Abdulla
Journal: International Journal of Surgery (2023)

Dear Editor, Infectious disease outbreaks at large gatherings can put a strain on the local health system and endanger both local and global health. The FIFA World Cup (FIFA-WC) is the biggest global mass gathering event in sports. Given its size and the variety of attendees, this event does indeed present unique challenges to hosting countries. One of the key challenges are the potential rapid spread of highly transmissible infectious disease among event attendees from imported or endemic communicable diseases due to close human proximity, such as seasonal influenza, measles, and other tropical endemic diseases1. The 22nd FIFA-WC 2022, taking place in Qatar from 20 November to 18 December 2022, is unique in a number of ways. Indeed, this is the first FIFA-WC to ever being hosted during an ongoing declared pandemic [i.e. coronavirus disease 2019 (COVID-19)]2,3. In addition to COVID-19, the monkeypox virus, causing the monkeypox disease (MPX), was declared a Public Health Emergency of International Concern in 23 July 2022. As of 8 November 2022, 77 430 confirmed cases were reported to WHO from several nonendemic countries worldwide corresponding to a short period of time preceding the FIFA-WC 2022 kick-off4,5. Moreover, Qatar, one of the smallest nations in the Middle East, is also the smallest nation in terms of population and territory to ever host the FIFA-WC2,3. During the event, Qatar is anticipating 1.7 million fans, which could potentially accelerate the spread of any emerging/outbreak of infectious diseases (e.g. MPX and/or COVID-19), due to the close contact of the concentrated crowd in a small area2,3. Therefore, to improve their emergency response and resilience, the Primary Health Care Corporation (PHCC), the main primary health facility in Qatar, overseeing 28 health centers, and Hamad Medical Corporation (HMC), the main provider of secondary and tertiary healthcare in Qatar, have assumed the responsibility for the FIFA-WC mass casualty incident plan5. Indeed, any shortcomings in earlier planning were being thoroughly investigated and fixed, and Qatar's hospitals and stockpiles are expected to have the capacity to handle the possibility of mass casualties during the FIFA-WC 2022. Most host countries of big mass gathering events (1) use healthcare technologies to assess disease risk and supplement conventional surveillance methods, particularly telemedicine, in addition to (2) enhancing their current monitoring systems6. Before the FIFA-WC in 2014 and for the Summer Olympics in 2016, telemedicine was adopted for the disaster and catastrophe preparedness of hospitals6. According to Dorigatti et al.7, a telemedicine disaster preparedness course was one way to get around the financial and logistical challenges of quick and decentralized team training while enhancing participants' knowledge. In preparation for the FIFA-WC 2022, Qatar has set the base for the use of telemedicine to: (1) manage potential challenges brought on by the FIFA-WC 2022 while (2) ensuring minimal impact on patient access to healthcare and continuity of care, (3) to limit the mass gathering inside hospitals, as well as (4) reducing traffic jams inside the country8. The three primary telemedicine plans established for FIFA-WC 2022 are: Telemedicine consultation for local citizens and expats In anticipation of the massive influx of fans expected during the FIFA-WC 2022, the PHCC has improved its telemedicine services. Indeed, the PHCC greatly boosted the use of virtual and e-services for consultations to manage issues brought on by the FIFA-WC while guaranteeing minimal impact on patient access to healthcare and continuity of care. A split of 70% virtual to 30% face-to-face consultations was scheduled to be in force from 1 November 2022, through 22 December 2022. This is aligned with the success of the resilience plan that has been implemented during the peak of the COVID-19 pandemic in Qatar. E-services, virtual, or online sessions are anticipated to play a significant role in consultations to ensure that both residents and nonresidents receive services while reducing footfall at health centers. In addition, unless the doctor requires a face-to-face encounter, all initial and follow-up meetings have been set to be scheduled as virtual consultations. PHCC is to convert all previously scheduled appointments to virtual consultations. In addition, to facilitate fluent communication with patients, PHCC now allows patients to obtain electronic sick leave certificates. Moreover, the PHCC website allows patients to book and/or arrange all prescription refills and home delivery through their mobile phone (E-services or phone calls). Through a governmental mobile application, patients can also access the E-services offered on the PHCC website for services including Request Appointments, Apply for Health Card(s), Add Dependents, Change Family Physician, Change Health Center, and Renew Health Card(s). In addition, walk-in and emergency services for family medicine, pediatrics, dental work, ear, nose, and throat (ENT), dermatology, cancer screenings, and ophthalmology will continue to be offered in person. Through the Community Call, patients can still make appointments for consultations. Importantly, a COVID-19 and monkeypox virus hotline has also been set up for this purpose. Ring vaccination for international travelers Visitors to Qatar can access medical care at any of the country's private or public hospitals, medical centers, clinics, and pharmacies9. For all visiting FIFA-WC supporters, the Qatari Ministry of Public Health (MoPH) has also established emergency phone numbers and decided that urgent healthcare services are provided free of charge at public hospitals (i.e. PHCC and HMC)9. The MoPH has, however, highly advised fans traveling to Qatar to purchase travel insurance (including healthcare coverage) for the duration of their stay. Telemedicine training for healthcare staff Increased use of telemedicine by healthcare staff has the potential to narrow training gaps, aid in program expansion, and provide safer patient care10. However, few studies report on the use of telemedicine for training healthcare staff, especially based on its success during the COVID-19 pandemic10. Indeed, telemedicine has proven to be a promising modality for providing healthcare staff with training and support during such critical times as pandemics. The logistical ease and low cost of telemedicine provide a platform for increased healthcare staff training, safety, and availability, particularly during the world's largest mass sporting event. The PHCC has planned to use telemedicine training for all staff during the FIFA-WC 2022 event as a measure of preparedness for any eventual emergency plan adjustments or the eventual implementation of new infection control protocols during the event. The COVID-19 pandemic is not over yet while MPX is another potential threat, Qatar healthcare authorities are facing challenging times while the country hosts the FIFA-WC 2022. The country has previously shown its capacity to face challenging sanitary situations. Indeed, Qatar was the first country to organize a football match with spectators during times of COVID-19 pandemic11 and the local professional football league resumed successfully at a time when the COVID-19 infectious rate was very high12. The telemedicine strategy that has been prepared in Qatar should constitute additional safeguards to prevent the spread of infectious disease during the FIFA-WC 2022. Even if we remain optimistic, we must emphasize that strict surveillance and eventual dynamic and versatile infection control policies are the main barriers to limiting potential infectious outbreaks at FIFA-WC 2022. Provenance and peer review Not commissioned, internally reviewed. Ethical approval Not applicable. Consent for publication All authors approved of the final version to be published and agreed to be accountable for any part of the work. Sources of funding Open access funding provided by the Qatar National Library. No external funding related to the project has been received. Authors' contribution I.D. and S.A.A.A.: conception and design. I.D., R.A.F., and M.R.: analysis and interpretation of the data. I.D., K.C., and R.A.F.: drafting of the paper. K.C., R.A.F., M.R., M.T., Z.A.M., and S.A.A.A.: revising it critically for intellectual content. All authors gave their final approval to the version that will be published. Conflicts of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not applicable. Guarantor All authors.